Multiple autoimmune manifestations in a splenectomized subject with HLA-B8.

Idiopathic thrombocytopenic purpura developed in a 31-year-old man, and he underwent a splenectomy because of his failure to respond to steroid therapy. Subsequently, during a six-year follow-up, chronic active hepatitis, Coombs' positive hemolytic anemia, and pulmonary interstitial fibrosis developed. Since such a clustering of autoimmune manifestations in a single subject is unusual, possible contributing factors were sought. We suggest that both the splenectomy and the histocompatibility antigen HLA-B8, which the patient was found to carry, may have contributed to this rare clinical syndrome.

Dead Sea bath salts for the treatment of rheumatoid arthritis.

Thirty patients with classical or definite rheumatoid arthritis were randomly divided into two groups of fifteen patients each of similar age, sex, duration and severity of disease, and medical treatment. All patients were treated once a day with bath salts heated to 35 degrees C for twenty minutes. Group I received Dead Sea bath salts and Group II, the control group, received sodium chloride (NaCl). The study was double-blind and of two weeks' duration. All patients were evaluated by one rheumatologist both before treatment, and two weeks later at the end of the treatment period. Follow-up evaluations were made one and three months after conclusion of the treatments. The clinical parameters evaluated included duration of morning stiffness, fifteen meter walk time, hand-grip strength, activities of daily living, circumference of proximal interphalangeal joints, number of active joints, Ritchie index and the patient's own assessment of disease activity. The laboratory parameters evaluated included erythrocyte sedimentation rate and serum levels of amyloid A, rheumatoid factor, sodium, potassium, calcium and magnesium. A statistically significant improvement (p less than 0.01 or p less than 0.05) was observed in Group I only, in most of the clinical parameters assessed. Maximal therapeutic effect was obtained at the end of the treatment and lasted up to one month.

Mud pack therapy in rheumatoid arthritis.

Twenty-eight patients with classical or definite rheumatoid arthritis were randomly divided into two groups of fourteen patients each. All patients were treated once a day with mud packs derived from the Dead Sea heated to 40 degrees C and applied over the four extremities, neck and back for 20 minutes. Group 1 was treated with the true mud packs and Group 2 with washed out and less concentrated mud packs. The study was double blind and of two weeks duration. All patients were evaluated by one rheumatologist both before treatment and two weeks later at the end of the treatment period. Follow-up evaluations were made one and three months after conclusion of the treatment. The clinical indices evaluated included duration of morning stiffness, hand-grip strength, activities of daily living, patient's own assessment of disease activity, number of active joints and the Ritchie index. A statistically significant improvement (p less than 0.01 or p less than 0.05) was observed in Group 1 only in most of the clinical indices, lasting between 1 to 3 months.

Palindromic rheumatism in Israel--a disease entity? A survey of 34 patients.

Over a period of 10 years 34 patients were diagnosed as suffering from palindromic rheumatism. Eighty-one percent of the patients were of North African origin. This is significantly higher (p = 0.01) than the age-adjusted origin of the general population in the region. Attacks were usually monoarthritic or oligoarthritic in nature. The joint most often involved was the knee. Prophylactic therapy with colchicine was ineffective. Gold salts brought about partial remission in three of six patients. Despite a relatively long average follow-up period of 9.3 years and the finding of a positive rheumatoid factor in 12% of the patients, not one of the patients developed rheumatoid arthritis. In 50% of the patients we detected an unexplained elevation in serum globulins and immunoglobulins. The possible association between this syndrome and Familial Mediterranean Fever is discussed.

[Black widow spider bite in the Negev].

In the 4 years, 1985-88, 9 adults bitten by black widow spiders (Latrodectus inactopus) were hospitalized. The syndrome of lactrodectism, not as yet described from the Negev, was mainly characterized in these patients by restlessness, profuse perspiration, severe abdominal pain and rigidity, and muscular twitching. In addition, in 2 cases there was gastrointestinal involvement, with ileus and gastric dilatation. These unique findings, not as yet reported, may be attributed to the particular type of a venom of the black widow spider in the Negev. All victims recovered with symptomatic treatment.

[Recurrent episodes of central retinal artery occlusion].

A 70-year-old man with arteriosclerosis of the carotid arteries developed acute occlusion of the central retinal artery and blindness during intravenous pyelography. 40 minutes after the occlusive episode he underwent paracentesis of the anterior chamber and vision returned (6/18). During the next 2 weeks, while receiving aspirin and then intravenous heparin, there were recurrent episodes of arterial occlusion and blindness that were immediately treated by repeated paracenteses of the anterior chamber. Visual activity again returned to 6/18 and his condition has remained stable as of his last clinic visit, 3 months after the first episode.

[Anaphylactic shock after traumatic rupture of a splenic echinococcal cyst].

Anaphylactic shock as a result of trauma is very rare. We describe a 20-year-old Druze soldier who presented with anaphylactic shock due to rupture of a splenic echinococcal cyst induced by blunt trauma to the left chest wall and upper abdomen. The main clinical manifestations, which developed within minutes of the trauma, were high fever, pruritus, edema of the lips and eyelids, dyspnea, stridor and rhinorrhea. Eosinophilia was not present on admission but appeared 4 days later. Surgery revealed an intact echinococcal cyst in the left lobe of the liver and another in the spleen. The splenic cyst was torn, filled with blood and its contents had spread throughout the splenic tissue, but without peritoneal spillage. Recovery was complete after splenectomy and resection of the hepatic hydatid cyst.

[Dead Sea bath salts for osteoarthritis of the knee].

26 patients with osteoarthritis of the knees were randomly divided into 2 groups of 13 each with patients of similar ages, sex distribution and duration and severity of disease. All were treated with daily baths at 34-35 degrees C for 20 min. containing Dead Sea bath salts (Group I) or sodium chloride (Group II). The study was double-blind and of 2 weeks duration. Patients were evaluated by a rheumatologist before, at the end of treatment and 1 month later. Clinical parameters evaluated included index of severity of osteoarthritis, patient's assessment of disease severity, range of movement of knees, soft tissue swelling, effusion and crepitus. There was significant improvement in the index of severity of osteoarthritis at the end of the treatment in both groups (p < 0.01). 1 month later, in Group I the significance of the index was still p < 0.01, but p < 0.05 in Group II. Patient's assessment of improvement was significant only in Group I at the end of the treatment period (p < 0.01). There was no statistical improvement in either group in the other parameters assessed.

Linear scleroderma, hemiatrophy and systemic lupus erythematosus.

A young woman, with linear scleroderma accompanied by body hemiatrophy since childhood, developed systemic lupus erythematosus. The rare coexistence of the 2 diseases is discussed.

Scabies-associated angioimmunoblastic lymphadenopathy.

A systemic disorder characterized by fever and reactive lymphadenopathy developed in a patient with scabies infestation. Regression of all clinical symptoms and signs occurred after antiscabies therapy. Two months later, the whole clinical picture reappeared concomitantly with scabies reinfestation. Subsequent lymph node biopsy demonstrated typical angioimmunoblastic lymphadenopathy (AILD). It is plausible that persistent antigenic stimulation caused by scabies infection was of pathogenetic importance in the induction of the syndrome of AILD. Infectious agents should be considered and looked for in patients with AILD, since they may play a role in the evolution of this disease.

Sulphur bath and mud pack treatment for rheumatoid arthritis at the Dead Sea area.

Forty patients with classical or definite rheumatoid arthritis in a stage of active disease were treated for two weeks at a spa hotel. The patients were divided into four groups of 10. Group I was treated with daily mud packs, group II with daily hot sulphur baths, group III with a combination of mud packs and hot sulphur baths, and group IV served as a control group. The patients were assessed by a rheumatologist who was blinded to the treatment modalities. Statistically significant improvement for a period of up to three months was observed in the three treatment groups in most of the clinical indices. Improvement in the control group was minor in comparison and not statistically significant. No significant improvement was observed in any of the laboratory variables measured. Except for three mild cases of thermal reaction there were no side effects.

Balneotherapy for rheumatoid arthritis at the Dead Sea.

Thirty-six patients with active rheumatoid arthritis were treated for 12 days at the Ein Gedi Spa. The patients were allocated randomly to four study groups. Group 1 (n = 9) was treated with daily baths in the Dead Sea, group 2 (n = 9) was treated with daily sulphur baths, group 3 (n = 10) was treated with a combination of daily Dead Sea bathing and sulphur baths, and group 4 (n = 8) served as a control group. All patients were assessed by a rheumatologist who was blinded to the treatment modalities and group allocation. Clinical parameters assessed included: duration of morning stiffness, 15 m walk time, grip strength, activities of daily living, patient's assessment of disease severity, number of active joints, and the Ritchie articular index. Statistically significant improvement lasting up to 3 months was observed only in the three treatment groups.